Panda, Ananya

AbstractAn 80-year-old man presented with new-onset pain in the shoulders and lower extremities and elevated serum inflammatory markers. A clinical diagnosis of polymyalgia rheumatica (PMR) was made, but there was a suboptimal response to glucocorticoid therapy, prompting further evaluation. 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) revealed intense FDG uptake in the arteries of the bilateral lower extremities, head, and neck, but sparing the aorta, suggestive of an uncommon pattern of giant cell arteritis (GCA). There were also imaging signs consistent with PMR, including FDG uptake in the synovium of large joints. This case highlights the uncommon manifestation of GCA with lower extremity involvement and sparing of the aorta. The combination of FDG PET imaging features and elevated serum markers obviated the need for invasive biopsy. One might also conclude that standard FDG PET/CT imaging protocols covering orbits/vertex to thighs incompletely evaluate the extent of arterial distribution of GCA.

ABSTRACTBACKGROUND AND PURPOSEThere is a relative paucity of radiology literature on spinal cord cavernous malformations (SCMs). We hypothesized that the classic MRI features of cavernous malformations are not highly prevalent. The purpose was to review MR imaging findings of SCMs with a focus on prevalence of hemorrhagic features, including adjacent intramedullary hemorrhage at initial presentation.METHODSIn this single‐institution study, 78 SCMs in 76 patients diagnosed on imaging/pathology were retrospectively evaluated for size, location, cord expansion, exophytic component, popcorn morphology, signal characteristics, including T1 weighted (T1w) and T2w rims, blood‐fluid levels, and adjacent intramedullary hemorrhage. Intramedullary hemorrhage was defined as centrally and/or eccentrically located linear or flame shaped non‐edematous signal abnormality extending longitudinally away from SCMs, distinct from lesional rim.RESULTSSixty‐three percent (49/78) of SCMs measured <1 cm in length, 78% (61/78) extended to the cord surface, 65% (51/78) were expansile, and 32% (25/78) were exophytic. Popcorn morphology was seen in 15% (12/78) on T1w and 22% (17/78) on T2w. Internal blood‐fluid levels were evident in 4% (3/78). Sixty‐nine percent (54/78) showed T2w hypointense rims; the T2w rim was complete/near‐complete in 37% (29/78). A rim on T1w was visible in 49% (38/78); this was hyperintense in 58% (22/38). Adjacent intramedullary hemorrhage was seen in 45/78 (58%), was most commonly bidirectional in 67% (30/45) and eccentric in 68% (30/44). Cord edema was seen in 22% (17/78); 53% (9/17) also demonstrated intramedullary hemorrhage with edema.CONCLUSIONSThe classically described popcorn morphology, internal blood‐fluid levels, and complete/near‐complete T2w hypointense rims are often absent on MRIs in SCMs. Adjacent intramedullary hemorrhage is frequently present, often eccentric and bidirectional.

Importance Preoperative assessment of nasal soft-tissue envelope (STE) thickness is an important component of rhinoplasty that presently lacks validated tools. Objective To measure and assess the distribution of nasal STE thickness in a large patient population and to determine if facial plastic surgery clinicians can predict nasal STE thickness based on visual examination of the nose. Design, Setting, and Participants This retrospective review and prospective assessment of 190 adult patients by 4 expert raters was conducted at an academic tertiary referral center. The patients had high-resolution maxillofacial computed tomography (CT) scans and standardized facial photographs on file and did not have a history of nasal fracture, septal perforation, rhinoplasty, or other surgery or medical conditions altering nasal form. Data were analyzed in March 2019. Main Outcomes and Measures Measure nasal STE thickness at defined anatomic subsites using high-resolution CT scans. Measure expert-predicted nasal STE thickness based on visual examination of the nose using a scale from 0 (thinnest) to 100 (thickest). Results Of the 190 patients, 78 were women and the mean (SD) age was 45 (17) years. The nasal STE was thickest at the sellion (mean [SD]) (6.7 [1.7] mm), thinnest at the rhinion (2.1 [0.7] mm), thickened over the supratip (4.8 [1.0] mm) and nasal tip (3.1 [0.6] mm), and thinned over the columella (2.6 [0.4] mm). In the study population, nasal STE thickness followed a nearly normal distribution for each measured subsite, with the majority of patients in a medium thickness range. Comparison of predicted and actual nasal STE thickness showed that experts could accurately predict nasal STE thickness, with the highest accuracy at the nasal tip ( r , 0.73; prediction accuracy, 91%). A strong positive correlation was noted among the experts’ STE estimates ( r , 0.83-0.89), suggesting a high level of agreement between individual raters. Conclusions and Relevance There is variable thickness of the nasal STE, which influences the external nasal contour and rhinoplasty outcomes. With visual analysis of the nose, experts can agree on and predict nasal STE thickness, with the highest accuracy at the nasal tip. These data can aid in preoperative planning for rhinoplasty, allowing implementation of preoperative, intraoperative, and postoperative strategies to optimize the nasal STE, which may ultimately improve patient outcomes and satisfaction. Level of Evidence NA .

Objective This study aims for targeted biopsy validation of magnetic resonance fingerprinting (MRF) and diffusion mapping for characterizing peripheral zone (PZ) prostate cancer and noncancers. Materials and Methods One hundred four PZ lesions in 85 patients who underwent magnetic resonance imaging were retrospectively analyzed with apparent diffusion coefficient (ADC) mapping, MRF, and targeted biopsy (cognitive or in-gantry). A radiologist blinded to pathology drew regions of interest on targeted lesions and visually normal peripheral zone on MRF and ADC maps. Mean T1, T2, and ADC were analyzed using linear mixed models. Generalized estimating equations logistic regression analyses were used to evaluate T1 and T2 relaxometry combined with ADC in differentiating pathologic groups. Results Targeted biopsy revealed 63 cancers (low-grade cancer/Gleason score 6 = 10, clinically significant cancer/Gleason score ≥7 = 53), 15 prostatitis, and 26 negative biopsies. Prostate cancer T1, T2, and ADC (mean ± SD, 1660 ± 270 milliseconds, 56 ± 20 milliseconds, 0.70 × 10−3 ± 0.24 × 10−3 mm2/s) were significantly lower than prostatitis (mean ± SD, 1730 ± 350 milliseconds, 77 ± 36 milliseconds, 1.00 × 10−3 ± 0.30 × 10−3 mm2/s) and negative biopsies (mean ± SD, 1810 ± 250 milliseconds, 71 ± 37 milliseconds, 1.00 × 10−3 ± 0.33 × 10−3 mm2/s). For cancer versus prostatitis, ADC was sensitive and T2 specific with comparable area under curve (AUC; (AUCT2 = 0.71, AUCADC = 0.79, difference between AUCs not significant P = 0.37). T1 + ADC (AUCT1 + ADC = 0.83) provided the best separation between cancer and negative biopsies. Low-grade cancer T2 and ADC (mean ± SD, 75 ± 29 milliseconds, 0.96 × 10−3 ± 0.34 × 10−3 mm2/s) were significantly higher than clinically significant cancers (mean ± SD, 52 ± 16 milliseconds, 0.65 ± 0.18 × 10−3 mm2/s), and T2 + ADC (AUCT2 + ADC = 0.91) provided the best separation. Conclusions T1 and T2 relaxometry combined with ADC mapping may be useful for quantitative characterization of prostate cancer grades and differentiating cancer from noncancers for PZ lesions seen on T2-weighted images.

BackgroundThe 3D breast magnetic resonance fingerprinting (MRF) technique enables T1 and T2 mapping in breast tissues. Combined repeatability and reproducibility studies on breast T1 and T2 relaxometry are lacking.PurposeTo assess test–retest and two‐visit repeatability and interscanner reproducibility of the 3D breast MRF technique in a single‐institution setting.Study TypeProspective.SubjectsEighteen women (median age 29 years, range, 22–33 years) underwent Visit 1 scans on scanner 1. Ten of these women underwent test–retest scan repositioning after a 10‐minute interval. Thirteen women had Visit 2 scans within 7–15 days in same menstrual cycle. The remaining five women had Visit 2 scans in the same menstrual phase in next menstrual cycle. Five women were also scanned on scanner 2 at both visits for interscanner reproducibility.Field Strength/SequenceTwo 3T MR scanners with the 3D breast MRF technique.AssessmentT1 and T2 MRF maps of both breasts.Statistical TestsMean T1 and T2 values for normal fibroglandular tissues were quantified at all scans. For variability, between and within‐subjects coefficients of variation (bCV and wCV, respectively) were assessed. Repeatability was assessed with Bland–Altman analysis and coefficient of repeatability (CR). Reproducibility was assessed with interscanner coefficient of variation (CoV) and Wilcoxon signed‐rank test.ResultsThe bCV at test–retest scans was 9–12% for T1, 7–17% for T2, wCV was <4% for T1, and <7% for T2. For two visits in same menstrual cycle, bCV was 10–15% for T1, 13–17% for T2, wCV was <7% for T1 and <5% for T2. For two visits in the same menstrual phase, bCV was 6–14% for T1, 15–18% for T2, wCV was <7% for T1, and <9% for T2. For test–retest scans, CR for T1 and T2 were 130 msec and 11 msec. For two visit scans, CR was <290 msec for T1 and 10–14 msec for T2. Interscanner CoV was 3.3–3.6% for T1 and 5.1–6.6% for T2, with no differences between interscanner measurements (P = 1.00 for T1, P = 0.344 for T2).Data Conclusion3D breast MRF measurements are repeatable across scan timings and scanners and may be useful in clinical applications in breast imaging.Level of Evidence: 2Technical Efficacy: Stage 2J. Magn. Reson. Imaging 2019;50:1133–1143.